Article Text
Abstract
Objectives This study aimed to describe the recovery journeys of people with a history of recurrent depression who took part in a psychosocial programme designed to teach skills to prevent depressive relapse (mindfulness-based cognitive therapy (MBCT)), alongside maintenance antidepressant medication (ADM).
Design A qualitative study embedded within a multicentre, single blind, randomised controlled trial (the PREVENT trial).
Setting Primary care urban and rural settings in the UK.
Participants 42 people who participated in the MBCT arm of the parent trial were purposively sampled to represent a range of recovery journeys.
Interventions MBCT involves eight weekly group sessions, with four refresher sessions offered in the year following the end of the programme. It was adapted to offer bespoke support around ADM tapering and discontinuation.
Methods Written feedback and structured in-depth interviews were collected in the 2 years after participants undertook MBCT. Data were analysed using thematic analysis and case studies constructed to illustrate the findings.
Results People with recurrent depression have unique recovery journeys that shape and are shaped by their pharmacological and psychological treatment choices. Their journeys typically include several over-arching themes: (1) beliefs about the causes of depression, both biological and psychosocial; (2) personal agency, including expectations about their role in recovery and treatment; (3) acceptance, both of depression itself and the recovery journey; (4) quality of life; (5) experiences and perspectives on ADM and ADM tapering-discontinuation; and (6) the role of general practitioners, both positive and negative.
Conclusions People with recurrent depression describe unique, complex recovery journeys shaped by their experiences of depression, treatment and interactions with health professionals. Understanding how several themes coalesce for each individual can both support their recovery and treatment choices as well as health professionals in providing more accessible, collaborative, individualised and empowering care.
Trial registration number Clinical trial number ISRCTN26666654; post results.
- depression & mood disorders
- psychological therapy
- antidepressants
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Footnotes
Twitter @WillemKuyken
Contributors WK, RB and NM were responsible for the PREVENT trial protocol (A randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment in the prevention of depressive relapse/recurrence) and secured the study funding. NM designed the over-arching qualitative process study to elicit service users’ experiences of treatment, with input from RB, FG, RH, JC and WK. Interviews were conducted by FG and AW, supervised by NM. CC, WK, JR and AT developed the analytical strategy and protocol for the study reported here, and AT conducted the bulk of the analysis, with input from other members of the analytical team. AT, CC and WK drafted the manuscript. All other authors read the manuscript, revised it for significant intellectual content and approved the final manuscript. As chief investigator, WK had overall responsibility for the parent trial within which this study was embedded. The University of Exeter held responsibility for the parent trial and this work. WK is guarantor and corresponding author for the study.
Funding The PREVENT trial was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (08/56/01) and was published in full in Health Technology Assessment. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, National Health Service or the Department of Health and Social Care. A trial steering committee, data and ethics monitoring committee, the UK Mental Health Research Network, the Primary Care Research Network, and the Comprehensive Local Research Network all provided support to the project. WK, CC and AT are supported by the Wellcome Trust (107496/Z/15/Z). RB received funding from NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Disclaimer The funders had no role in the design of the study, in the collection, analysis and interpretation of the data, in the writing of the report or in the decision to submit the article for publication. All authors are independent of the funders, had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The South West Research Ethics Committee approved the trial (09/H0206/43), which was registered with the International Standard Randomised Controlled Trial Register (ISRCTN26666654) and the Medicines and Healthcare products Regulatory Agency (2009-012428-10).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. We will not be making the data publicly available due to its highly confidential and identifiable nature.